From Primary Cytoreduction to Second-Line Chemotherapy and Rucaparib

A 64-year-old woman came to the University of California San Diego with persistent abdominal bloating, low back pain, early satiety, and fatigue—symptoms pointing toward a possible gynecologic malignancy. Her prior medical history included a hysterectomy for benign reasons, hypothyroidism, and generalized anxiety. Physical examination revealed diffuse lumbosacral pain, abdominal distension, and ascites. Imaging further identified a 5 cm complex ovarian mass, omental thickening (“omental cake”), ascites, and retroperitoneal as well as inguinal adenopathy, strongly suggesting metastatic ovarian cancer.

Diagnostic paracentesis and biopsy of the omentum confirmed high-grade serous ovarian cancer (HGSC). Germline and somatic genetic tests showed no BRCA1/2 mutations and that her tumor was homologous recombination proficient (HRP). The patient underwent primary surgical cytoreduction, successfully removing all visible disease. Post-surgery, she was treated with carboplatin and paclitaxel (TC) every 3 weeks, followed by maintenance bevacizumab to prolong progression-free survival.

Despite initial success, her CA-125 levels rose at one year, prompting imaging that exposed recurrent retroperitoneal disease. She was deemed ineligible for secondary surgery due to disease distribution and was re-challenged with six cycles of carboplatin and paclitaxel. Although she achieved a partial response, residual enlarged lymph nodes persisted. Seeking the best possible outcome, she opted for switch maintenance therapy using single-agent rucaparib, a PARP inhibitor indicated for patients with recurrent platinum-sensitive ovarian cancer—even without a BRCA mutation—when other options are limited.